You or someone that you know at one point in time has had a moment when you bend over to pick up something from the ground or simply bent over to brush your teeth over the sink and instantly felt excruciating back pain. You then ask yourself, “What did I do wrong? Should I have bent my knees? Why does my back go out without warning?”
The answer is related to the nerve supply to the spine.
Our ability to feel pain and everyday sensations, such as touch and movement, is very different in all parts of thd body. For example, we are very aware of everything that happens inside the mouth when we eat food but the nerve supply is quite different to the deeper structures of our bodies, such as the stomach.
When we chew we can taste and feel the food until we swallow. Then once the food reaches the stomach, we only partially feel it; it continues into the digestive tract and we completely lose track of it. Because of this lack of sensitivity, it is not unusual for an ulcer to develop without noticing any symptoms at all.
The nerve supply to the spine is similar to the stomach because you can feel some things, but the pain threshold is relatively high. So, the pain of an ulcer or back problem builds up more over time and only seems to come out of nowhere when the damage has progressed enough.
People assume when the back “goes out” that tension has been accumulating in the muscles and caused it to go into spasm.
This is partially true because often the real problem is in the joints. Stress and inflammation can build up in them without any signs or symptoms until the body decides it is more important to protect that joint than to bend over. Most of the spasm involved in the back attack is mainly the muscles protecting an inflamed, misaligned joint.
This is the type of problem that responds to manipulation. Stretches and other kinds of exercises cannot put a joint back into alignment.
Most patients try to wait it out when their back goes into spasm or just get a prescription for a painkiller. But one episode tends to lead to another, and each episode makes it more likely another will occur. If this cycle is not stopped, it may lead to chronic low back pain, which is so common it has been estimated to have the highest “chronic disease burden” in the world.
When a patient has a history of back attacks, we tell them the first goal of treatment is relief of the acute pain, but the next phase is to correct the underlying joint and muscle problems that caused it in the first place. These are problems that can be completely painless. One of the most difficult parts of treating a patient with this problem is getting them to continue to take their condition seriously, after the acute pain has responded to treatment. Many patients don’t get this idea until they go through several “rounds” of care for these acute episodes. This is especially true if the episodes start to get more and more frequent, are more easily triggered or start to involve some leg pain.
If the underlying problem is not corrected, it does not go away on its own.